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In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
The role of myocardial perfusion imaging in evaluating patients with myocardial bridging
Kun Tang1, Ling Wang, Rongfang Shi
1Department of Radiology, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, 325000, Zhejiang Province, China.
Insights
Myocardial bridging (MB) can cause myocardial ischemia. Myocardial perfusion imaging (MPI) effectively identifies ischemia related to MB, especially when there is severe systolic narrowing of the coronary artery segment.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Congenital Heart Abnormalities
Background:
- Myocardial bridging (MB) is a common congenital coronary anomaly with unclear clinical significance regarding myocardial ischemia.
- Myocardial perfusion imaging (MPI) is utilized to assess ischemia in coronary artery disease and evaluate MB's hemodynamic impact.
Purpose of the Study:
- To determine the utility of MPI in evaluating patients with MB.
- To identify MB characteristics associated with perfusion defects detected by MPI.
Main Methods:
- Thirty-nine patients with MB of the left anterior descending artery underwent coronary angiography and stress-rest MPI.
- Patients with other forms of heart disease were excluded.
Main Results:
- MPI identified perfusion defects in 20.5% of MB patients, a significantly higher rate than stress electrocardiography.
- Severe systolic narrowing of the bridging segment was significantly associated with a higher rate of reversible perfusion defects.
- MB length and location did not significantly correlate with abnormal MPI findings.
Conclusions:
- MPI is an effective noninvasive tool for evaluating MB.
- The degree of systolic narrowing in MB is more closely linked to resulting myocardial ischemia than MB length or location.
Background:
Myocardial bridging (MB) is a common, congenital coronary-abnormality that is found on average in one out of every three adults at autopsy (Moehlenkamp et al in Circulation, 106:2616-2622, 2002; Erbel et al in Circulation, 120:357-359, 2009). However, its clinical significance and impact on myocardial ischemia remains controversial and unclear. Myocardial perfusion imaging (MPI) is widely used to assess myocardial ischemia in patients with known or suspected coronary artery disease, and is frequently performed to evaluate the hemodynamic significance of MB. This study was undertaken to determine the use of MPI in evaluating MB and to identify the characteristics of MB associated with perfusion defects using MPI.
Methods And Results:
Thirty-nine patients with MB of the left anterior descending (LAD) artery as documented by coronary angiography (CA) were enrolled for this study. None of the patients exhibited other forms of heart disease as determined by both CA and stress-rest MPI, no later than 1 month prior to the study. Using MPI, eight patients (20.5%) were found to have perfusion defects in the corresponding myocardial areas. This frequency was significantly higher when compared with results obtained by stress electrocardiogram. The difference in the mean systolic narrowing of bridging segments was statistically significant between patients with and without ischemia. The positive rate of reversible defects in patients with severe systolic narrowing was significantly higher than in patients with mild-to-moderate systolic narrowing. However, there was no significant difference either between the mean length of the tunneled artery in patients with and without abnormal MPI or the positive rate of abnormal MPI in patients with different locations of the tunneled artery.
Conclusions:
MPI is an effective, noninvasive technique for the evaluation of patients with MB. The myocardial ischemia that resulted from bridging is associated more closely with the degree of systolic narrowing than with the length of tunneled artery or the location of MB.
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